Nonspecific aorto-arteries

In the USSR, like in other countries, aorto-arteritis is no rarity. Onehundred and twentysix patients with aorto-arteritis have been studied at the A.N. Bakulev Institute for Cardio-Vascular surgery during the past 13 years (81 women and 45 men from 8 to 49 years of age). Morphologic changes consisted in inflammatory infiltration of the adventitia and, to a lesser degree, of the media as well as in reactive hyperplasia of the intima. The predominant features in the chronic stage were those of sclerosis and fibrosis of the adventitia and the media which in combination with the intimal hyperplasia resulted in stenosis or occlusion of the aorta and its main branches. The clinical picture and symptpmatology depend largely on the localization, form, and severity of the lesions. In aorto-arteritis ischemia of various organs and hypertension can be eliminated only by radical reconstructive surgery of the aorta and its branches. The most adequate restoration of the blood flow in the major vessels is provided by resection combined with replacement. It is not quite clear yet whether endarterectomy is possible and justified. Radical surgery was performed in 80 patients. In addition, different palliative and explorative operations were performed in 10 patients. The majority of patients had resection with replacement of the brachiocephalic arteries, descending thoracic aorta, abdominal aorta, renal and visceral arteries. Blood flow in the major vessels was restored in 69 patients. Early postoperative thrombosis of the prosthesis occurred in 7 patients. Immediate postoperative mortality was 13.3 percent. Sixtytwo patients were followed up from 1 to 9 years after radical surgery. Persistent normalization or significant improvement of the systemic and regional hemodynamics was found in 53 patients. Late thrombosis of the aorto-renal branch or aorto-femoral prosthesis occurred in 4 patients. There were three late deaths.